Bilateral epibulbar rheumatoid nodulosis. A new ocular entity

Area of Science:

• Ophthalmology
• Rheumatology
• Pathology

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints.
• Rheumatoid nodules are a common extra-articular manifestation of RA, typically occurring in subcutaneous tissues.
• Rheumatoid nodulosis is a specific rheumatologic designation for the development of multiple subcutaneous nodules in the context of inactive RA.

Observation:

• A 61-year-old woman with a 9-year history of quiescent rheumatoid arthritis presented with 16 painless, bilateral episcleral rheumatoid nodules.
• The ocular lesions developed without any exacerbation of her underlying joint disease.
• Histopathological examination of the nodules revealed characteristic features of rheumatoid nodules within the conjunctiva and episclera.

Findings:

• Biopsy confirmed lymphocytic and plasmacytic infiltration, palisading granulomas with epithelioid histiocytes, multinucleated giant cells, and necrobiotic degeneration of collagen.
• These findings are consistent with rheumatoid nodules.
• This represents the first documented case of rheumatoid nodulosis involving the ocular adnexa.

Implications:

• This case expands the known spectrum of ocular manifestations of rheumatoid arthritis.
• It highlights the importance of considering rheumatoid nodulosis in the differential diagnosis of episcleral nodules, even in patients with seemingly inactive disease.
• Further research may elucidate the specific mechanisms driving ocular adnexal involvement in quiescent RA.